1
|
An Y, Kim S, Kwon D, Lee K, Yoon H. Computed tomographic measurements of pancreatic thickness in clinically normal dogs. Front Vet Sci 2023; 10:1254672. [PMID: 38026648 PMCID: PMC10652753 DOI: 10.3389/fvets.2023.1254672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Pancreatic thickness is an indicator for evaluating pancreatic diseases. The transverse and cross-sectional pancreatic thickness observed on computed tomography (CT) may differ. This study aimed to provide a normal reference range for pancreatic thickness on the transverse plane based on body weight (BW) and assess pancreatic thickness to aorta (P/Ao) ratio. In addition, we aimed to establish the normal short and long dimensions of the pancreas based on cross-sectional image through the long axis of the pancreas using multiplanar reconstruction (MPR). The short dimension to aorta (S/Ao) and long dimension to aorta (L/Ao) ratios were also established in clinically normal dogs. The pancreatic thickness was measured using CT results of 205 clinically normal dogs. The pancreatic thickness on the transverse plane and the short and long dimensions in the cross-sectional image of the pancreas were measured using MPR. The diameter of the Ao was measured on the transverse plane and the P/Ao, S/Ao, and L/Ao ratios were calculated. Our study showed that the mean normal pancreatic thicknesses (mean ± standard deviation [SD]) of the pancreatic body, left and right lobe in the transverse plane were 10.92 ± 2.54 mm, 8.92 ± 2.26 mm and 9.96 ± 2.24 mm, respectively. The P/Ao ratios of the pancreatic body, left and right lobes were 1.85 ± 0.33, 1.50 ± 0.27 and 1.68 ± 0.29, respectively. The mean short dimension (mean ± SD) in the cross-sectional image of the pancreatic body, left and right lobe were 8.98 ± 1.97 mm, 7.99 ± 1.89 mm and 8.76 ± 2.03 mm, respectively. In conclusion, pancreatic thickness increased with BW, while the P/Ao, S/Ao, and L/Ao ratios could be used regardless of BW.
Collapse
Affiliation(s)
- Yoojin An
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan-si, Jeollabuk-do, Republic of Korea
| | - Sungsoo Kim
- VIP Animal Medical Center, Seoul, Republic of Korea
| | - Danbee Kwon
- Bundang Leaders Animal Medical Center, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kichang Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan-si, Jeollabuk-do, Republic of Korea
| | - Hakyoung Yoon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan-si, Jeollabuk-do, Republic of Korea
| |
Collapse
|
2
|
van Andel MM, de Waard V, Timmermans J, Scholte AJHA, van den Berg MP, Zwinderman AH, Mulder BJM, Groenink M. Aortic distensibility in Marfan syndrome: a potential predictor of aortic events? Open Heart 2021; 8:openhrt-2021-001775. [PMID: 34702778 PMCID: PMC8549677 DOI: 10.1136/openhrt-2021-001775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives Patients with Marfan syndrome (MFS) are prone to develop aortic aneurysms due to fragmentation of elastic fibres, resulting in reduced distensibility of the aorta. Reduced distensibility was previously shown to predict progressive descending aorta dilatation. Here, we investigated longitudinal changes in distensibility, as a potential predictor of aortic events. Methods This retrospective study included all patients with MFS with at least four cardiac magnetic resonance examinations performed between 1996 and 2012. Aortic distensibility was assessed, in the ascending (level 1), proximal descending (level 2) and distal descending (level 3) aorta. Changes in distensibility were studied using linear mixed-effects regression models. Results In total, 35 patients with MFS (age at inclusion 28 (IQR 23–32) years, 54% men) were included. Mean aortic distensibility was already low (between 2.9×10–3/mm Hg/year and 6.4×10–3/mm Hg/year) at all levels at baseline, and significantly decreased over time at levels 2 and 3 (respectively, p=0.012 and p=0.002). The rate of distensibility loss per year (×10-3/mm Hg/year) was 0.01, 0.03 and 0.06×10–3/mm Hg at levels 1, 2 and 3, respectively. At inclusion, men exhibited very low distensibility, whereas women showed moderately reduced distensibility, gradually decreasing with age. Aortic dilatation rate at level 2 was associated with reduced aortic distensibility. However, we could not demonstrate a direct correlation between distensibility and clinical events during a follow-up of 22 years. Conclusion Patients with MFS display reduced aortic distensibility already at an early age, inversely relating to aortic dilatation rate. However, in this selected patient group, distensibility seems less suitable as an individual predictor of aortic events.
Collapse
Affiliation(s)
- Mitzi M van Andel
- Cardiology, Amsterdam UMC - Location AMC, Amsterdam, The Netherlands
| | - Vivian de Waard
- Medical Biochemistry, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
| | | | | | | | - Aeilko H Zwinderman
- Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
| | | | - Maarten Groenink
- Cardiology, Amsterdam UMC - Location AMC, Amsterdam, The Netherlands .,Radiology, Amsterdam UMC - Location AMC, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Teraa M, Hazenberg CE, Houben IB, Trimarchi S, van Herwaarden JA. Important issues regarding planning and sizing for emergent TEVAR. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:708-712. [PMID: 32964898 DOI: 10.23736/s0021-9509.20.11571-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the past decades, treatment of acute thoracic aortic syndrome underwent drastic changes with a central role for thoracic endovascular aortic repair (TEVAR). One of the essential factors in the success of TEVAR is accurate sizing of the endograft, as both under- and oversizing can lead to suboptimal results and disastrous complications. The aim of this review was to give an overview of issues regarding endograft sizing in emergent TEVAR. Sizing of the endograft can be complicated by specific factors related to the underlying disease. For instance, different types of the acute thoracic aortic syndrome, i.e. blunt thoracic injury, thoracic aortic aneurysm or dissection with concomitant rupture are associated with hemorrhagic shock and the need for resuscitation, which leads to profound changes in diameter of the thoracic aorta. These diameter changes should be taken into account during endograft sizing. Measuring the thoracic aorta based on the admission CTA can lead to inaccurate sizing, even if proper centerline-based measurements are performed. The use of real-time imaging, in particular intravascular ultrasound (IVUS), has been shown to provide more accurate endograft sizing in acute thoracic aortic syndromes, especially if associated with hypovolemia. Future research should provide additional data on the exact role of different intra-operative imaging modalities (e.g. IVUS, transesophageal echocardiography [TEE], three dimensional CTA) on endograft sizing and long-term outcomes to ultimately improve patient outcome.
Collapse
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands -
| | | | - Ignas B Houben
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Santi Trimarchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
4
|
Zubair MM, de Beaufort HW, Belvroy VM, Schwein A, Irshad A, Mohamed A, Gomez LF, Chinnadurai P, Nabi F, Yang EY, Trimarchi S, Reardon MJ, Bismuth J. Impact of Cardiac Cycle on Thoracic Aortic Geometry—Morphometric Analysis of Ecg Gated Computed Tomography. Ann Vasc Surg 2020; 65:174-182. [DOI: 10.1016/j.avsg.2019.10.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/24/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022]
|
5
|
Houben IB, van Bakel TMJ, Burris NS, Moll FL, van Herwaarden JA, Patel HJ. Critical appraisal of multidimensional CT measurements following acute open repair of type A aortic dissection. J Card Surg 2020; 35:634-644. [PMID: 32027413 PMCID: PMC7079063 DOI: 10.1111/jocs.14446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION To identify patients with aneurysmal degeneration of the native aorta following type A aortic dissection (TAAD), reproducible serial measurements of aortic dimensions are critical. We used a systematic workflow for measuring aortic geometry following TAAD, using computed tomography angiography data, and test its reproducibility. METHODS The workflow for aortic measurements included centerline generation, luminal diameter, and area measurement at six anatomically defined locations along the aorta and luminal volumetric measurements in the descending aorta. Two independent observers measured the aortic geometry in 20 surgically repaired TAAD patients, preoperatively and at 3 months follow-up. To test reproducibility, intraobserver and interobserver agreement scores were analyzed using a concordance correlation coefficient (CCC). RESULTS The interobserver agreement scores of the diameter, area, and volumetric measurements in the descending aorta were acceptable. The agreement scores of the area measurements were highest, with CCCs ranging from 0.909 to 0.984. Luminal diameter measurements scored lower than luminal area measurements and were least reproducible at the mid aortic arch (CCC < 0.886). Overall, intraobserver agreement scores were better than interobserver agreement scores (SD of mean difference was 1.89 vs 1.94 for intraobserver vs interobserver diameter measurements, and 0.61 vs 0.66 for area measurements). CONCLUSION Although overall reproducibility was acceptable in descending aortic measurements, our results show that it remains challenging to reliably measure luminal diameters, compared with areas. To aid identification of early adverse remodeling following acute TAAD, novel two- and three-dimensional measurement techniques are needed that capture locoregional changes in the false lumen and true lumen morphology more accurately.
Collapse
Affiliation(s)
- Ignas B Houben
- Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan Health Center, Ann Arbor, Michigan
| | - Theodorus M J van Bakel
- Department of Vascular Surgery, Frankel Cardiovascular Center, University of Michigan Health Center, Ann Arbor, Michigan
| | - Nicholas S Burris
- Department of Radiology, University of Michigan Health Center, Ann Arbor, Michigan
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Heidelberglaan, The Netherlands
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Heidelberglaan, The Netherlands
| | - Himanshu J Patel
- Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan Health Center, Ann Arbor, Michigan
| |
Collapse
|
6
|
Jadidi M, Habibnezhad M, Anttila E, Maleckis K, Desyatova A, MacTaggart J, Kamenskiy A. Mechanical and structural changes in human thoracic aortas with age. Acta Biomater 2020; 103:172-188. [PMID: 31877371 DOI: 10.1016/j.actbio.2019.12.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Abstract
Aortic mechanical and structural characteristics have profound effects on pathophysiology, but many aspects of physiologic stress-stretch state and intramural changes due to aging remain poorly understood in human tissues. While difficult to assess in vivo due to residual stresses and pre-stretch, physiologic stress-stretch characteristics can be calculated using experimentally-measured mechanical properties and constitutive modeling. Mechanical properties of 76 human descending thoracic aortas (TA) from 13 to 78-year-old donors (mean age 51±18 years) were measured using multi-ratio planar biaxial extension. Constitutive parameters were derived for aortas in 7 age groups, and the physiologic stress-stretch state was calculated. Intramural characteristics were quantified from histological images and related to aortic morphometry and mechanics. TA stiffness increased with age, and aortas became more nonlinear and anisotropic. Systolic and diastolic elastic energy available for pulsation decreased with age from 30 to 8 kPa and from 18 to 5 kPa, respectively. Cardiac cycle circumferential stretch dropped from 1.14 to 1.04, and circumferential and longitudinal physiologic stresses decreased with age from 90 to 72 kPa and from 90 to 17 kPa, respectively. Aortic wall thickness and radii increased with age, while the density of elastin in the tunica media decreased. The number of elastic lamellae and circumferential physiologic stress per lamellae unit remained constant with age at 102±10 and 0.85±0.04 kPa, respectively. Characterization of mechanical, physiological, and structural features in human aortas of different ages can help understand aortic pathology, inform the development of animal models that simulate human aging, and assist with designing devices for open and endovascular aortic repairs. STATEMENT OF SIGNIFICANCE: This manuscript describes mechanical and structural changes occurring in human thoracic aortas with age, and presents material parameters for 4 commonly used constitutive models. Presented data can help better understand aortic pathology, inform the development of animal models that simulate human aging, and assist with designing devices for open and endovascular aortic repairs.
Collapse
Affiliation(s)
- Majid Jadidi
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Mahmoud Habibnezhad
- Department of Computer Science, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Eric Anttila
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Kaspars Maleckis
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States; Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, United States
| | - Anastasia Desyatova
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States; Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, United States
| | - Jason MacTaggart
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Alexey Kamenskiy
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States; Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, United States.
| |
Collapse
|
7
|
Endovascular Repair of Blunt Thoracic Aortic Trauma is Associated With Increased Left Ventricular Mass, Hypertension, and Off-target Aortic Remodeling. Ann Surg 2020; 274:1089-1098. [PMID: 31904600 DOI: 10.1097/sla.0000000000003768] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aortic elasticity creates a cushion that protects the heart from pressure injury, and a recoil that helps perfuse the coronary arteries. TEVAR has become first-line therapy for many aortic pathologies including trauma, but stent-grafts stiffen the aorta and likely increase LV afterload. OBJECTIVE Test the hypothesis that trauma TEVAR is associated with LV mass increase and adverse off-target aortic remodeling. METHODS Computed Tomography Angiography (CTA) scans of 20 trauma TEVAR patients (17 M/3 F) at baseline [age 34.9 ± 18.5 (11.4-71.5) years] and 5.1 ± 3.1 (1.1-12.3) years after repair were used to measure changes in LV mass, LV mass index, and diameters and lengths of the ascending thoracic aorta (ATA). Measurements were compared with similarly-aged control patients without aortic repair (21 M/21 F) evaluated at similar follow-ups. RESULTS LV mass and LV mass index of TEVAR patients increased from 138.5 ± 39.6 g and 72.35 ± 15.17 g/m to 173.5 ± 50.1 g and 85.48 ± 18.34 g/m at the rate of 10.03 ± 12.79 g/yr and 6.25 ± 10.28 g/m/yr, whereas in control patients LV characteristics did not change. ATA diameters of TEVAR patients increased at a rate of 0.60 ± 0.80 mm/yr, which was 2.4-fold faster than in controls. ATA length in both TEVAR and control patients increased at 0.58 mm/yr. Half of TEVAR patients had hypertension at follow-up compared to only 5% at baseline. CONCLUSIONS TEVAR is associated with LV mass increase, development of hypertension, and accelerated expansile remodeling of the ascending aorta. Although younger trauma patients may adapt to these effects, these changes may be even more important in older patients with other aortic pathologies and diminished baseline cardiac function.
Collapse
|
8
|
Affiliation(s)
| | - David A. Green
- School of Mathematical Sciences, University of Adelaide, Adelaide, Australia
| | - Andrew V. Metcalfe
- School of Mathematical Sciences, University of Adelaide, Adelaide, Australia
| |
Collapse
|
9
|
Ferrer CJ, Bos C, Yoneyama M, Obara M, Kok L, van Leeuwen MS, Bleys RLAW, Moonen CTW, Bartels LW. Respiratory- and cardiac-triggered three-dimensional sheath inked rapid acquisition with refocused echoes imaging (SHINKEI) of the abdomen for magnetic resonance neurography of the celiac plexus. Eur Radiol Exp 2019; 3:14. [PMID: 30923930 PMCID: PMC6439132 DOI: 10.1186/s41747-019-0095-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022] Open
Abstract
The visualisation of the celiac plexus using respiratory- and cardiac-triggered three-dimensional (3D) sheath inked rapid acquisition with refocused echoes imaging (SHINKEI) was evaluated. After ethical approval and written informed consent, eight volunteers (age 27 ± 5 years, mean ± standard deviation) were scanned at 1.5 and 3 T. Displacement of the celiac ganglia due to aortic pulsatility was studied on axial single-slice breath-hold balanced turbo field-echo cine sequences in five volunteers and found to be 3.0 ± 0.5 mm (left) and 3.1 ± 0.4 mm (right). Respiratory- and cardiac-triggered 3D SHINKEI images were compared to respiratory- and cardiac-triggered fat-suppressed 3D T2-weighted turbo spin-echo and respiratory-triggered 3D SHINKEI in all volunteers. Visibility of the celiac ganglia was rated by three radiologists as visible or non-visible. On 3D SHINKEI with double-triggering at 1.5 T, the left and right ganglia were seen by all observers in 7/8 and 8/8 volunteers, respectively. At 3 T, this was the case for 6/8 and 7/8 volunteers, respectively. The nerve-to-muscle signal ratio increased from 1.9 ± 0.5 on fat-suppressed 3D T2-weighted turbo spin-echo to 4.7 ± 0.8 with 3D SHINKEI. Anatomical validation was performed in a human cadaver. An expert in anatomy confirmed that the hyperintense structure visible on ex vivo 3D SHINKEI scans was the celiac plexus. In conclusion, double-triggering allowed visualisation of the celiac plexus using 3D SHINKEI at both 1.5 T and 3 T.
Collapse
Affiliation(s)
- Cyril J Ferrer
- Imaging Division, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Clemens Bos
- Imaging Division, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Masami Yoneyama
- Philips Japan, 3-37 Kohnan 2-chome, Minato-ku, Tokyo, 108-8507, Japan
| | - Makoto Obara
- Philips Japan, 3-37 Kohnan 2-chome, Minato-ku, Tokyo, 108-8507, Japan
| | - Lisanne Kok
- Imaging Division, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maarten S van Leeuwen
- Department of Radiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Chrit T W Moonen
- Imaging Division, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Utrecht University, Domplein 29, 3512 JE, Utrecht, The Netherlands
| | - Lambertus W Bartels
- Imaging Division, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| |
Collapse
|
10
|
Marconi S, Lanzarone E, van Bogerijen GHW, Conti M, Secchi F, Trimarchi S, Auricchio F. A compliant aortic model for in vitro simulations: Design and manufacturing process. Med Eng Phys 2018; 59:21-29. [PMID: 30077485 DOI: 10.1016/j.medengphy.2018.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/28/2018] [Accepted: 04/30/2018] [Indexed: 11/29/2022]
Abstract
We design and manufacture a silicone model of the human aorta, able to mimic both the geometrical and the mechanical properties of physiological individuals, with a specific focus on reproducing the compliance. In fact, while the models available in the literature exhibit an unrealistic compliant behavior, though they are detailed from the geometrical viewpoint, here the goal is to provide an accurate compliant tool for in vitro testing the devices that interface with the vascular system. A parametric design of the aortic model is obtained based on the available literature data, and the model is manufactured with a specific silicone mixture using rapid prototyping and molding techniques. The manufactured prototype has been tested by means of computed tomography scans for evaluating the matching of the mechanical properties with the desired ones. Results show a high degree of adherence between the imposed and the measured compliance values for each main aortic section. Thus, our work proves the feasibility of the approach, and the possibility to manufacture compliant models that reproduce the mechanical behavior of the aorta for in vitro studies.
Collapse
Affiliation(s)
- Stefania Marconi
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy.
| | - Ettore Lanzarone
- Institute for Applied Mathematics and Information Technologies, Consiglio Nazionale delle Ricerche (CNR), Milan, Italy
| | | | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Francesco Secchi
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Santi Trimarchi
- Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Department of Scienze Biomediche per la Salute, University of Milan, Milan, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| |
Collapse
|
11
|
Lin JM, Patterson AJ, Chao TC, Zhu C, Chang HC, Mendes J, Chung HW, Gillard JH, Graves MJ. Free-breathing black-blood CINE fast-spin echo imaging for measuring abdominal aortic wall distensibility: a feasibility study. Phys Med Biol 2017; 62:N204-N218. [PMID: 28327475 DOI: 10.1088/1361-6560/aa685a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The paper reports a free-breathing black-blood CINE fast-spin echo (FSE) technique for measuring abdominal aortic wall motion. The free-breathing CINE FSE includes the following MR techniques: (1) variable-density sampling with fast iterative reconstruction; (2) inner-volume imaging; and (3) a blood-suppression preparation pulse. The proposed technique was evaluated in eight healthy subjects. The inner-volume imaging significantly reduced the intraluminal artifacts of respiratory motion (p = 0.015). The quantitative measurements were a diameter of 16.3 ± 2.8 mm and wall distensibility of 2.0 ± 0.4 mm (12.5 ± 3.4%) and 0.7 ± 0.3 mm (4.1 ± 1.0%) for the anterior and posterior walls, respectively. The cyclic cross-sectional distensibility was 35 ± 15% greater in the systolic phase than in the diastolic phase. In conclusion, we developed a feasible CINE FSE method to measure the motion of the abdominal aortic wall, which will enable clinical scientists to study the elasticity of the abdominal aorta.
Collapse
Affiliation(s)
- Jyh-Miin Lin
- Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom. Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
A Novel Insight into the Role of Entry Tears in Type B Aortic Dissection: Pressure Measurements in an in Vitro Model. Int J Artif Organs 2017; 40:563-574. [DOI: 10.5301/ijao.5000627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2017] [Indexed: 12/20/2022]
Abstract
Introduction Predicting aortic growth in acute type B dissection is fundamental in planning interventions. Several factors are considered to be growth predictors in the literature and, among them, size and location of entry tears have been recognized to particularly influence the false lumen pressure. In this study, we develop an in vitro setting to analyze the actual impact of size and location of the entry tears on false lumen pressure, in the absence of other confounding factors such as the deformability of the aortic wall. Methods We formalize some indexes that synthetically describe the false lumen pressure with respect to the true lumen pressure. Then, we experimentally derive their values in several configurations of the in vitro setting, and we look for trends in the indexes with respect to the size and location of entry tears. Results: Results show that the tears have a relevant impact on the false lumen pressure, but that their size and location alone are not enough to explain the phenomena observed in vivo. Conclusions To predict the behavior of acute type B dissection, we therefore recommend not limiting to size and location, as many effects may derive from the interactions between these parameters and other patient characteristics.
Collapse
|
13
|
Nauta FJH, van Bogerijen GHW, Conti M, Trentin C, Moll FL, Van Herwaarden JA, Auricchio F, Trimarchi S. Impact of Thoracic Endovascular Repair on Pulsatile Aortic Strain in Acute Type B Aortic Dissection: Preliminary Results. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2017; 5:42-52. [PMID: 28868315 DOI: 10.12945/j.aorta.2017.16.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 03/12/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The impact of thoracic endovascular aortic repair (TEVAR) on pulsatile aortic strain remains undetermined in patients with Type B aortic dissection (TBAD). Therefore, we quantified pulsatile aortic strain in TBAD patients and control subjects. METHODS We retrospectively analyzed two TBAD patients from our database with cardiac-gated computed tomography angiography imaging available before and after TEVAR and two control subjects (67- and 76-year-old males). Patient 1 (54-year-old female) presented with acute TBAD, and Patient 2 (55-year-old male) had Marfan syndrome and ruptured acute TBAD. Custom-developed software was used to compute aortic length, diameter, and area during the cardiac cycle. Pulsatile strain was calculated as systolic increments of length and circumference divided by corresponding diastolic values. RESULTS Before TEVAR, pulsatile longitudinal strain of the thoracic aorta was lower in TBAD patients (1.4-1.7%) than in control subjects (2.1-4.5%). After TEVAR, pulsatile longitudinal strain increased proximal to the stent-graft by 65% in the arch of Patient 1 and by 70% in the ascending aorta of Patient 2. Pulsatile circumferential strain was elevated in false lumen patency (4.4-6.2%) compared with thrombosed false lumen (1.4-2.1%) or control subjects (0.9-3.3%). Following TEVAR, circumferential measurements within stented segments were deemed unreliable due to artifacts. CONCLUSIONS TEVAR led to a considerable increase of pulsatile longitudinal strain proximal to the stent-grafts, and TBAD was associated with longitudinally stiffer aortas, which may be part of the pathophysiology of TEVAR-related complications such as retrograde dissection and aneurysmal dilatation. These preliminary data call for larger prospective studies.
Collapse
Affiliation(s)
- Foeke J H Nauta
- Thoracic Aortic Research Center, Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Guido H W van Bogerijen
- Thoracic Aortic Research Center, Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Michele Conti
- Structural Mechanics Division, Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - Chiara Trentin
- CESNA Center for Advanced Numerical Simulations, Istituto Universitario di Studi Superiori di Pavia (IUSS), Pavia, Italy
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Ferdinando Auricchio
- Structural Mechanics Division, Department of Civil Engineering and Architecture, University of Pavia, Italy.,CESNA Center for Advanced Numerical Simulations, Istituto Universitario di Studi Superiori di Pavia (IUSS), Pavia, Italy
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| |
Collapse
|
14
|
Petrini J, Eriksson MJ, Caidahl K, Larsson M. Circumferential strain by velocity vector imaging and speckle-tracking echocardiography: validation against sonomicrometry in an aortic phantom. Clin Physiol Funct Imaging 2017; 38:269-277. [DOI: 10.1111/cpf.12410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/22/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Johan Petrini
- Department of Molecular Medicine and Surgery; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Physiology; Södersjukhuset; Stockholm Sweden
| | - Maria J. Eriksson
- Department of Molecular Medicine and Surgery; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Physiology; Karolinska University Hospital; Stockholm Sweden
| | - Kenneth Caidahl
- Department of Molecular Medicine and Surgery; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Physiology; Karolinska University Hospital; Stockholm Sweden
| | - Matilda Larsson
- Department of Molecular Medicine and Surgery; Karolinska Institutet; Stockholm Sweden
- Department of Medical Engineering; School of Technology and Health; KTH Royal Institute of Technology; Stockholm Sweden
| |
Collapse
|
15
|
de Beaufort H, Nauta F, Conti M, Cellitti E, Trentin C, Faggiano E, van Bogerijen G, Figueroa C, Moll F, van Herwaarden J, Auricchio F, Trimarchi S. Extensibility and Distensibility of the Thoracic Aorta in Patients with Aneurysm. Eur J Vasc Endovasc Surg 2017; 53:199-205. [DOI: 10.1016/j.ejvs.2016.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 11/15/2016] [Indexed: 12/31/2022]
|
16
|
Nauta FJH, van Bogerijen GHW, Trentin C, Conti M, Auricchio F, Moll FL, van Herwaarden JA, Trimarchi S. Impact of Thoracic Endovascular Aortic Repair on Pulsatile Circumferential and Longitudinal Strain in Patients With Aneurysm. J Endovasc Ther 2017; 24:281-289. [DOI: 10.1177/1526602816687086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To quantify both pulsatile longitudinal and circumferential aortic strains before and after thoracic endovascular aortic repair (TEVAR), potentially clarifying TEVAR-related complications. Methods: This retrospective study assessed the impact of TEVAR on pulsatile aortic strains through custom developed software and cardiac-gated computed tomography imaging of 8 thoracic aneurysm patients (mean age 71.0±8.2 years; 6 men) performed before TEVAR and during follow-up (median 0.1 months, interquartile range 0.1–5.8). Lengths of the ascending aorta, the aortic arch, and the descending aorta were measured. Diameters and areas were computed at the sinotubular junction, brachiocephalic trunk, left subclavian artery, and the celiac trunk. Pulsatile longitudinal and circumferential strains were quantified as systolic increments of length and circumference divided by the corresponding diastolic values. Results: Average pulsatile longitudinal strain ranged from 1.4% to 7.1%, was highest in the arch (p<0.001), and increased after TEVAR by 77% in the arch (7.1%±2.5% vs 12.5%±5.1%, p=0.04) and by 69% in the ascending aorta (5.6±2.3% vs 9.4±4.4%, p=0.06). Average pulsatile circumferential strain ranged from 3.6% to 5.0% before TEVAR and did not differ significantly throughout the thoracic aorta; there was a nonsignificant increase after TEVAR at the unstented sinotubular junction (5.0%±1.4% vs 6.3%±1.0%, p=0.18), with a significant increase at the celiac trunk (3.6%±1.8% vs 6.2%±1.8%, p=0.02). Pulsatile circumferential strains within stented segments were deemed unreliable due to image artifacts. Conclusion: TEVAR was associated with an increase of pulsatile longitudinal strains (in the arch) and circumferential strains (at the celiac trunk) in unstented aortic segments. These observations suggest increased pulsatile wall stress after TEVAR in segments adjacent to the device, which may contribute to the understanding of stent-graft–related complications such as retrograde dissection, aneurysm formation, and rupture.
Collapse
Affiliation(s)
- Foeke J. H. Nauta
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Guido H. W. van Bogerijen
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Chiara Trentin
- Istituto Universitario di Studi Superiori di Pavia (IUSS), Pavia, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, Structural Mechanics Division, University of Pavia, Italy
| | - Ferdinando Auricchio
- Istituto Universitario di Studi Superiori di Pavia (IUSS), Pavia, Italy
- Department of Civil Engineering and Architecture, Structural Mechanics Division, University of Pavia, Italy
| | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | | | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
| |
Collapse
|
17
|
Zandvoort HJ, Moll FL, Domanian A, van Keulen JW, Vonken EJP, van Herwaarden JA. Preoperative Infra- and Suprarenal Aortic Pulsatile Distension is Comparable between Relatively Young and Older Patients with an Abdominal Aortic Aneurysm. Ann Vasc Surg 2014; 28:845-9. [DOI: 10.1016/j.avsg.2013.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 06/02/2013] [Accepted: 07/18/2013] [Indexed: 01/21/2023]
|
18
|
van Bogerijen GH, Tolenaar JL, Conti M, Auricchio F, Secchi F, Sardanelli F, Moll FL, van Herwaarden JA, Rampoldi V, Trimarchi S. Contemporary Role of Computational Analysis in Endovascular Treatment for Thoracic Aortic Disease. AORTA (STAMFORD, CONN.) 2013; 1:171-181. [PMID: 26798690 PMCID: PMC4682739 DOI: 10.12945/j.aorta.2013.13-003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 07/12/2013] [Indexed: 06/05/2023]
Abstract
In the past decade, thoracic endovascular aortic repair (TEVAR) has become the primary treatment option in descending aneurysm and dissection. The clinical outcome of this minimally invasive technique is strictly related to an appropriate patient/stent graft selection, hemodynamic interactions, and operator skills. In this context, a quantitative assessment of the biomechanical stress induced in the aortic wall due to the stent graft may support the planning of the procedure. Different techniques of medical imaging, like computed tomography or magnetic resonance imaging, can be used to evaluate dynamics in the thoracic aorta. Such information can also be combined with dedicated patient-specific computer-based simulations, to provide a further insight into the biomechanical aspects. In clinical practice, computational analysis might show the development of aortic disease, such as the aortic wall segments which experience higher stress in places where rupture and dissection may occur. In aortic dissections, the intimal tear is usually located at the level of the sino-tubular junction and/or at the origin of the left subclavian artery. Besides, computational models may potentially be used preoperatively to predict stent graft behavior, virtually testing the optimal stent graft sizing, deployment, and conformability, in order to provide the best endovascular treatment. The present study reviews the current literature regarding the use of computational tools for TEVAR biomechanics, highlighting their potential clinical applications.
Collapse
Affiliation(s)
- Guido H.W. van Bogerijen
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy
| | - Jip L. Tolenaar
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, Structural Mechanics Division, University of Pavia, Pavia, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, Structural Mechanics Division, University of Pavia, Pavia, Italy
| | - Francesco Secchi
- Department of Radiology, Policlinico San Donato IRCCS, University of Milan, Milan, Italy; and
| | - Francesco Sardanelli
- Department of Radiology, Policlinico San Donato IRCCS, University of Milan, Milan, Italy; and
| | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Vincenzo Rampoldi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy
| |
Collapse
|
19
|
Wang XL, Thompson MM, Dole WP, Dalman RL, Zalewski A. Standardization of outcome measures in clinical trials of pharmacological treatment for abdominal aortic aneurysm. Expert Rev Cardiovasc Ther 2012; 10:1251-60. [PMID: 23113642 DOI: 10.1586/erc.12.128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
An abdominal aortic aneurysm (AAA) is a common aortic wall disease with an increased prevalence in the elderly population (4-8% for those aged >65 years). Many AAAs are slow growing and remain insidious. Current standard of care for patients with small AAAs (<49 mm) is surveillance, with interventional therapy (open surgical repair or endovascular aneurysm repair) recommended for large (>50-55 mm), rapidly growing (>10 mm/year) or symptomatic AAAs. Although open surgical repair or endovascular aneurysm repair are effective, significant short- and long-term postoperative morbidity and mortality occurs. Currently, there is no pharmacological treatment specific for AAA; the need for the development of targeted pharmacological therapies based on clinically relevant and feasible outcomes acceptable to the medical community, regulatory agencies and third-party payers is high. A consensus on such end points will be critical to accelerating the development of pharmacological agents to prevent formation, arrest the expansion and reduce the rupture risk of AAA.
Collapse
Affiliation(s)
- Xing Li Wang
- Cardiovascular Science Unit, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
| | | | | | | | | |
Collapse
|
20
|
Defining acute aortic syndrome after trauma: Are Abbreviated Injury Scale codes a useful surrogate descriptor? J Trauma Acute Care Surg 2012; 73:977-82. [PMID: 22914077 DOI: 10.1097/ta.0b013e31825570d3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The severity and location of injuries resulting from vehicular collisions are normally recorded in Abbreviated Injury Scale (AIS) code; we propose a system to link AIS code to a description of acute aortic syndrome (AAS), thus allowing the hypothesis that aortic injury is progressive with collision kinematics to be tested. METHODS Standard AIS codes were matched with a clinical description of AAS. A total of 199 collisions that resulted in aortic injury were extracted from a national automotive collision database and the outcomes mapped onto AAS descriptions. The severity of aortic injury (AIS severity score) and stage of AAS progression were compared with collision kinematics and occupant demographics. Post hoc power analyses were used to estimate maximum effect size. RESULTS The general demographic distribution of the sample represented that of the UK population in regard to sex and age. No significant relationship was observed between estimated test speed, collision direction, occupant location or seat belt use and clinical progression of aortic injury (once initiated). Power analysis confirmed that a suitable sample size was used to observe a medium effect in most of the cases. Similarly, no association was observed between injury severity and collision kinematics. CONCLUSION There is sufficient information on AIS severity and location codes to map onto the clinical AAS spectrum. It was not possible, with this data set, to consider the influence of collision kinematics on aortic injury initiation. However, it was demonstrated that after initiation, further progression along the AAS pathway was not influenced by collision kinematics. This might be because the injury is not progressive, because the vehicle kinematics studied do not fully represent the kinematics of the occupants, or because an unknown factor, such as stage of cardiac cycle, dominates. LEVEL OF EVIDENCE Epidemiologic/prognostic study, level IV.
Collapse
|
21
|
de Heer LM, Budde RP, van Prehn J, Mali WP, Bartels LW, Stella PR, van Herwerden LA, Kluin J, Vincken KL. Pulsatile Distention of the Nondiseased and Stenotic Aortic Valve Annulus: Analysis With Electrocardiogram-Gated Computed Tomography. Ann Thorac Surg 2012; 93:516-22. [DOI: 10.1016/j.athoracsur.2011.08.068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 10/14/2022]
|
22
|
Hurks R, Pasterkamp G, Vink A, Hoefer IE, Bots ML, van de Pavoordt HD, de Vries JPP, Moll FL. Circumferential heterogeneity in the abdominal aortic aneurysm wall composition suggests lateral sides to be more rupture prone. J Vasc Surg 2012; 55:203-9. [DOI: 10.1016/j.jvs.2011.06.113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 06/22/2011] [Accepted: 06/24/2011] [Indexed: 12/27/2022]
|
23
|
Jonker FHW, van Keulen JW, Schlosser FJV, Indes JE, Moll FL, Verhagen HJM, Muhs BE. Thoracic aortic pulsatility decreases during hypovolemic shock: implications for stent-graft sizing. J Endovasc Ther 2011; 18:491-6. [PMID: 21861735 DOI: 10.1583/10-3374.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate the thoracic aortic pulsatility during hypovolemic shock in an experimental porcine model. METHODS The circulating blood volume of 7 healthy Yorkshire pigs was gradually lowered until the subjects had lost 40% of their normal blood volume. Intravascular ultrasound was used to assess the aortic pulsatility in normovolemic and hypovolemic state at the level of the ascending and descending thoracic aorta. RESULTS The mean aortic pulsatility at the level of the ascending aorta decreased from 15.9% ± 7.2% (range 6.3%-25.7%) in normovolemia to 6.2% ± 2.8% (range 2.9%-10.7%, p = 0.018) in hypovolemia. At the level of the descending thoracic aorta, the mean aortic pulsatility decreased from 8.7% ± 2.8% (range 4.4%-12.2%) at baseline to 5.6% ± 2.5% (range 1.5%-9.5%, p = 0.028) in hypovolemia. The maximum mean aortic diameter, obtained in cardiac systole, was significantly smaller as well at both evaluated levels during hypovolemic shock compared with the mean diameter in normovolemia. CONCLUSION The thoracic aortic diameter and pulsatility decreased significantly during hypovolemic shock in this porcine model, most impressively at the level of the ascending aorta. Electrocardiographically-gated imaging may not be necessary for hypovolemic patients with acute aortic disease requiring endovascular repair because of the minimal aortic pulsatility.
Collapse
|
24
|
de Heer LM, Budde RPJ, Mali WPTM, de Vos AM, van Herwerden LA, Kluin J. Aortic root dimension changes during systole and diastole: evaluation with ECG-gated multidetector row computed tomography. Int J Cardiovasc Imaging 2011; 27:1195-204. [PMID: 21359833 PMCID: PMC3230759 DOI: 10.1007/s10554-011-9838-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 02/16/2011] [Indexed: 10/27/2022]
Abstract
Cardiac pulsatility and aortic compliance may result in aortic area and diameter changes throughout the cardiac cycle in the entire aorta. Until this moment these dynamic changes could never be established in the aortic root (aortic annulus, sinuses of Valsalva and sinotubular junction). The aim of this study was to visualize and characterize the changes in aortic root dimensions during systole and diastole with ECG-gated multidetector row computed tomography (MDCT). MDCT scans of subjects without aortic root disease were analyzed. Retrospectively, ECG-gated reconstructions at each 10% of the cardiac cycle were made and analyzed during systole (30-40%) and diastole (70-75%). Axial planes were reconstructed at three different levels of the aortic root. At each level the maximal and its perpendicular luminal dimension were measured. The mean dimensions of the total study group (n = 108, mean age 56 ± 13 years) do not show any significant difference between systole and diastole. The individual dimensions vary up to 5 mm. However, the differences range between minus 5 mm (diastolic dimension is greater than systolic dimensions) and 5 mm (vice versa). This variability is independent of gender, age, height and weight. This study demonstrated a significant individual dynamic change in the dimensions of the aortic root. These results are highly unpredictable. Most of the healthy subjects have larger systolic dimensions, however, some do have larger diastolic dimensions.
Collapse
Affiliation(s)
- Linda M de Heer
- Department of Cardio-Thoracic Surgery, Division of Heart and Lungs, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
25
|
Kim J, Baek S. Circumferential variations of mechanical behavior of the porcine thoracic aorta during the inflation test. J Biomech 2011; 44:1941-7. [DOI: 10.1016/j.jbiomech.2011.04.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 04/19/2011] [Accepted: 04/19/2011] [Indexed: 11/24/2022]
|
26
|
Gonçalves FB, van Herwaarden JA, Verhagen HJM. Insights on the prevention of endograft collapse after thoracic endovascular aortic repair. J Endovasc Ther 2010; 17:735-7. [PMID: 21142481 DOI: 10.1583/10-3130c1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
27
|
Melissano G, Civilini E, Rinaldi E, Chiesa R. Commentary: Toward a Better Understanding of Endograft Collapse After Thoracic Endovascular Aortic Repair. J Endovasc Ther 2010; 17:738-43. [DOI: 10.1583/10-3130c2.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
28
|
van Keulen J, Moll F, Barwegen G, Vonken E, van Herwaarden J. Pulsatile Distension of the Proximal Aneurysm Neck is Larger in Patients with Stent Graft Migration. Eur J Vasc Endovasc Surg 2010; 40:326-31. [DOI: 10.1016/j.ejvs.2010.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 05/18/2010] [Indexed: 10/19/2022]
|
29
|
van Keulen J, Vincken K, van Prehn J, Tolenaar J, Bartels L, Viergever M, Moll F, van Herwaarden J. The Influence of Different Types of Stent Grafts on Aneurysm Neck Dynamics after Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2010; 39:193-9. [DOI: 10.1016/j.ejvs.2009.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 10/06/2009] [Indexed: 10/20/2022]
|
30
|
van Prehn J, Schlösser F, Muhs B, Verhagen H, Moll F, van Herwaarden J. Oversizing of Aortic Stent Grafts for Abdominal Aneurysm Repair: A Systematic Review of the Benefits and Risks. Eur J Vasc Endovasc Surg 2009; 38:42-53. [DOI: 10.1016/j.ejvs.2009.03.025] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 03/30/2009] [Indexed: 11/30/2022]
|
31
|
van Prehn J, van Herwaarden JA, Vincken KL, Verhagen HJ, Moll FL, Bartels LW. Asymmetric aortic expansion of the aneurysm neck: Analysis and visualization of shape changes with electrocardiogram-gated magnetic resonance imaging. J Vasc Surg 2009; 49:1395-402. [DOI: 10.1016/j.jvs.2009.02.216] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 02/19/2009] [Accepted: 02/19/2009] [Indexed: 11/29/2022]
|